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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 343625383
Report Date: 04/08/2025
Date Signed: 04/11/2025 04:38:44 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/02/2025 and conducted by Evaluator Andrea Cortez
COMPLAINT CONTROL NUMBER: 03-CC-20250402094121
FACILITY NAME:THOMPSON, TORINFACILITY NUMBER:
343625383
ADMINISTRATOR:FACILITY TYPE:
810
ADDRESS:TELEPHONE:
CITY:STATE: ZIP CODE:
CAPACITY:8CENSUS: 4DATE:
04/08/2025
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Torin ThompsonTIME COMPLETED:
12:16 PM
ALLEGATION(S):
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Criminal Record Clearance - Uncleared Adult Living in the Home
INVESTIGATION FINDINGS:
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At 9:15am on 4/8/2025, Licensing Program Analyst (LPA) Andrea Cortez met with licensee Torin Thompson and explained the above complaint allegation. Upon arrival LPA observed 3 pre-school aged children, and 1 infant.

LPA observed the uncleared adult was in the kitchen washing dishes. Licensee stated the unknown person moved into the home March 31, 2025.

The preponderance of evidence standard has been met. Therefore, the above allegation is SUBSTANTIATED. A Type A Title 22 Deficiency has been cited on the attached LIC 9099-D. An immediate civil penalty has been assessed in the amount of $500. Appeal Rights were provided. An exit interview was conducted, and a Notice of Site Visit posted.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
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Control Number 03-CC-20250402094121
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO CC RO, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: THOMPSON, TORIN
FACILITY NUMBER: 343625383
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/08/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/09/2025
Section Cited
CCR
102370(d)(1)
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Criminal Record Clearance. All individuals subject to a criminal record review as specified in Section 1596.871 prior to working, residing or volunteering in a licensed home. All adult persons shall obtain a backround clearance or a criminal record exemption as required by the Department. LPA observed uncleared adult in the home and did not have criminal record clearance.

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Licensee shall obtain a criminal record clearance for all individuals prior to working/living in the home. No individual shall not be allowed to work/live in the facility until a criminal record clearance is obtained. Civil Penalties apply and assessed in the amount of $500.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Amanda Blesi
LICENSING EVALUATOR NAME: Andrea Cortez
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2025
LIC9099 (FAS) - (06/04)
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